June 18--The establishment of a 24-hour, freestanding emergency department after the loss of the hospitals in Bamberg and Barnwell counties is being seen as a way to address the changes in rural health care while providing citizens with needed services.

The Regional Medical Center in Orangeburg has proposed building a $8.63 million, 20,500-square-foot emergency department to serve the two counties. Construction could begin as early as this summer on the project that was first announced during a special called meeting of Bamberg County Council on June 12.

Sen. Brad Hutto, D-Orangeburg, Sen. John Matthews, D-Bowman, and Rep. Justin Bamberg, D-Bamberg, were among the government officials present for the announcement, along with Southern Carolina Alliance Executive Director Danny Black, RMC Board Chairman Melvin Seabrooks and Brenda Williams, vice president of strategy and compliance at RMC.

Columbia-based GMK Associates Inc. is the company handling the architectural design and construction of the facility. Bryant Brown, who serves as a vice president and health care planning consultant at GMK Associates, also attended Monday's meeting.

"Health care in rural South Carolina is changing, has been changing and will continue to change. We've been trying to come up with some ideas of what to do," Hutto said.

The Bamberg County Hospital Board voted to close its hospital's doors in April 2012. Southern Palmetto Hospital, formerly Barnwell County Hospital, announced its closure in January 2016.

The new 24/7 facility will be located on 10 acres of land adjacent to Highway 70 between the cities of Denmark and Barnwell. It will be funded by the state through a one-time, $3.6 million Transformation Fund Grant and additional funds resulting from the region's designation as a persistent poverty area. Other funding has been committed by local community stakeholders.

During the special meeting, Hutto said Southern Carolina Alliance, the economic development group that serves Bamberg and Barnwell counties, is set to close out its purchase of the 10-acre site on June 23, with construction to start shortly thereafter.

"Hopefully, construction will start within three months. This time next year, it'll be open for business," SCA's Black said.

Hutto said the project "vision" involves expansion to include mental health and alcohol and drug-treatment services and private physician practices.

"We believe the future is bright. We see a positive coming out of this," said Hutto, who welcomed council's input in naming the facility.

The facility will offer 24-hour emergency care to include CT scanning, X-ray and ultrasound diagnostic imaging and lab and observation services.

Brown said the facility will have all the amenities needed for a standard emergency department, including 13 observation rooms, and will be equipped to handle ambulance and walk-in traffic.

Williams said three observation beds will be available to take care of patients overnight. Incoming patients will access not just emergency care, but diagnostic services and outpatient lab and X-ray services, she said.

The projection is five doctors providing services to patients in the emergency department, Williams said.

Hutto said RMC's affiliation with telehealth medical services through a partnership with the Medical University of South Carolina will be a big plus for the new emergency department.

He said individuals in emergency situations will no longer have to travel long distances, adding that the "health care desert" the region has become will be revitalized and "hopefully benefit everybody."

Bamberg Rescue Squad Operations Manager Martha Hammett said, "Yes, we will utilize it. It is good news to us."

Councilman Trent Kinard asked how the facility's operation would be affected by factors like individuals with no insurance.

Hutto said the state has adjusted the Medicaid reimbursement rate through which RMC receives those funds, with the increased revenue from that incentive serving to keep the operation afloat. Medicaid is the state-run insurance system for low-income residents.

Matthews later said the process of improving health care in the region started approximately 2-{ years ago. He said "there's no question" about the emergency department's sustainability because the state (South Carolina Department of Health and Human Services) has put the proper monetary incentives in place.

"We changed RMC's classification from an urban hospital -- which it should have never been -- to a rural hospital, and that changed the reimbursement rate from 47 percent to 80 percent. So in doing that, they asked us to provide health care for the two proposed counties," Matthews said.

"We had to build a facility and operate it. They will be operating at a net loss, but the new revenue will cover that. Something is better than nothing. I think it's absolutely beneficial to Bamberg and Barnwell counties, and it will also be beneficial to the Regional Medical Center," he said.

Williams said, "We're going to get a little enhanced reimbursement for this project. The state sees the need for services in Bamberg and Barnwell counties. The service itself will operate at a loss, but we think our enhanced reimbursements will help us to sustain or support the effort. With the anticipated growth in the area, we are hoping that the payer mix in that area will change over the future and that we will be able to grow the service."

"I think it's going to make a positive difference in some cases where time is a big factor," she said. "Those areas at this given time can't sustain a hospital. With a freestanding emergency room and a regional hub like the Regional Medical Center being able to take care of those that really need inpatient care and more specialized needs, I think that will certainly serve the community well."

RMC opened an urgent care center in Bamberg in 2013 after the Bamberg County Hospital closed. Hutto said that facility will close once the new emergency department is up and running. Williams said some staff members from the urgent care center will be transferred to the new facility.

Bamberg County Council Chairman Evert Comer Jr. said, "It's certainly good news for this area." He noted that while there will be challenges, he is optimistic that even bigger things will stem from the emergency department.

"I'm sure the hospital wouldn't enter into a venture like that without having looked into every aspect of its viability," Comer said. "I know it's going to be over a year before it's a reality, but we're on that path. So I'm satisfied. A hospital would have been better, but it's good that we've got the emergency room coming."

"I believe that in rural America, the days of every single county having its hospital have long sailed," Rep. Bamberg said. "Twenty-four-hour emergency departments are the future of emergency medicine in rural and less-privileged areas as far as economics and population size."

The legislator said he is not concerned about the facility's financial future.

"All business ventures have risks ... this is most certainly a risk worth taking. What I anticipate us seeing is that this venture is going to be successful and can serve as somewhat of an example for others to follow," Bamberg said, adding that the project is not about politics but meeting critical health care needs.

Rep. Lonnie Hosey, D-Allendale, said, "If you don't have anything, you've got to take on what you can to help the situation. This could be a conduit to help us get to where we need to go in case we have an emergency. I'm in agreement with the movement on this.

"Everyone would want a hospital in their back door or front door, but that's not going to be possible. In the future, things are going to the regional concept. We weren't quite sure what the model should be but after several studies, it looked like the emergency room was the best option."

Black said he appreciated RMC for its dedication, along with the legislative members who helped get project funding.

"You always have people that are going to be negative about it, but in the end, it's the right thing to do at the right time and with the right team," he said. "We're ready to go."